MEDICARE: MR. MATT WAYNE PIERCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1982960100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATT WAYNE PIERCE

Provider Business Mailing Address
First Line	:	5929 N MAY AVE STE 506
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3925
Country	:	US
Telephone Number	:	405-947-7555
Fax Number	:	580-242-4679

Provider Business Practice Location Address
First Line	:	5929 N MAY AVE STE 506
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3925
Country	:	US
Telephone Number	:	405-947-7555
Fax Number	:	580-242-4697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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Directions to “ MR. MATT WAYNE PIERCE ” Practice Location

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